Provider Demographics
NPI:1265848550
Name:JORDAN, ADRIANNA (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ADRIANNA
Middle Name:
Last Name:JORDAN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9450 W CABELA DR APT 4177
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-1304
Mailing Address - Country:US
Mailing Address - Phone:618-421-5454
Mailing Address - Fax:
Practice Address - Street 1:2406 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7912
Practice Address - Country:US
Practice Address - Phone:602-956-3580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS020575183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist